Can losartan be given in patients with End-Stage Renal Disease (ESRD)?

From the Guidelines

Losartan can be given to patients with end-stage renal disease (ESRD), with a recommended dose of 50-100 mg/day, and regular monitoring of electrolyte balance and serum creatinine is necessary. According to the guidelines for the use of drugs in chronic kidney disease 1, losartan is recommended for the treatment of hypertension or renal failure in type 2 diabetes with microalbuminuria. The dose of 50-100 mg/day is specified, and it is essential to monitor electrolyte balance and serum creatinine regularly.

When using losartan in ESRD patients, it is crucial to be aware of the potential risk of hyperkalemia, which is already elevated in these patients. Close monitoring of blood pressure, potassium levels, and renal function parameters is necessary when initiating therapy or adjusting doses. Losartan works by blocking angiotensin II receptors, which helps reduce blood pressure and may provide cardioprotective effects even in ESRD patients.

Some key points to consider when giving losartan to ESRD patients include:

• Starting with a dose of 50-100 mg/day and adjusting as needed
• Regular monitoring of electrolyte balance and serum creatinine
• Close monitoring of blood pressure and potassium levels
• Being cautious about the risk of hyperkalemia
• Considering consultation with a nephrologist, especially if the patient has complex comorbidities or is on multiple medications, as stated in the guidelines for the use of drugs in chronic kidney disease 1.

From the FDA Drug Label

Losartan is indicated for the treatment of diabetic nephropathy with an elevated serum creatinine and proteinuria (urinary albumin to creatinine ratio ≥300 mg/g) in patients with type 2 diabetes and a history of hypertension In this population, losartan reduces the rate of progression of nephropathy as measured by the occurrence of doubling of serum creatinine or end stage renal disease (need for dialysis or renal transplantation) Treatment with losartan resulted in a 16% risk reduction in this endpoint Treatment with losartan also reduced the occurrence of sustained doubling of serum creatinine by 25% and ESRD by 29% as separate endpoints

Losartan can be used in patients with ESRD, but the decision to use it should be made on a case-by-case basis, considering the individual patient's condition and medical history.

• The primary benefit of losartan in patients with ESRD is to reduce the risk of doubling of serum creatinine and ESRD.
• However, caution should be exercised when using losartan in patients with ESRD, as the evidence is based on a specific population with type 2 diabetes and a history of hypertension. 2 2

From the Research

Losartan in ESRD

• Losartan is an angiotensin receptor blocker (ARB) commonly used to manage hypertension and protect the kidneys from further damage.
• According to the study 3, ARBs like losartan are reasonable first-line agents for managing hypertension in patients with end-stage renal disease (ESRD).
• The study 3 also notes that ACE inhibitors and ARBs exert cardioprotective effects that are independent of blood pressure reduction, which can be beneficial for patients with ESRD.
• However, it is essential to consider the potential risks of hyperkalemia associated with the use of ARBs in patients with ESRD, as mentioned in the studies 4, 5, and 6.
• The decision to use losartan in patients with ESRD should be individualized, taking into account the patient's comorbidities, medication removal with dialysis, and the potential for intradialytic hypotension, as discussed in the study 3.

Key Considerations

• Patients with ESRD are at a high risk of developing hyperkalemia, and the use of medications like losartan should be carefully monitored to avoid exacerbating this condition 4, 5, and 6.
• The management of hypertension in patients with ESRD is crucial, and losartan may be a suitable option for some patients, but it is essential to weigh the potential benefits against the risks, as noted in the study 3.
• Regular monitoring of serum potassium levels and adjustment of medication as needed is crucial to minimize the risk of hyperkalemia in patients with ESRD taking losartan, as mentioned in the studies 4 and 6.